August 17, 2012Though post-traumatic stress disorder is often associated with war veterans, many sufferers have yet to finish high school.According to the National Survey of Adolescents, about 4 percent of teenage boys and 6 percent of teenage girls meet the clinical definition of PTSD.But adolescents can be hard to diagnose.‘A Total Nightmare’The night Stephanie Romero turned 23, she and a friend were attacked by a stranger.“My friend went outside to have a cigarette, and there was this guy — he came out; he was harassing us,” she says.The man hit her and her friend, leaving Romero shocked.“It was just a total nightmare,” she says. “I think about it all the time. I’ve never gone through anything like that.”After the attack, Romero’s friends and family noticed she was acting differently. She didn’t go out as often. Her weight started changing. She was really depressed. Later, doctors diagnosed her with post-traumatic stress disorder.“I was like, PTSD? I thought it was just for veterans,” Romero says. “But I found out it’s not; it’s for anyone who’s experienced an event where you keep thinking about it and it takes over your life.”A Chemical Called CortisolI can relate. When I was 15, my mom was murdered. I tried everything I could to deal with my feelings, including writing songs.But still, something was different about me. I noticed that I didn’t feel like my normal self anymore, not only mentally, but physically. I was losing weight, and my hair was falling out.

“That’s a pretty clear symptom that things aren’t going well,” says Jamal Harris, a pediatrician at a community health center in San Francisco. Harris says he sees teens with PTSD at his clinic all the time, and that many of them have physical symptoms related to their stress.“Some examples in teens would be problems sleeping, weight gain, and just being frustrated,” Harris says.It turns out a lot of those changes are due to hormones your body makes in response to stress. This can be a good thing. For example, if a car comes at you all of a sudden while you’re crossing the street, your body produces a chemical called cortisol, which helps you react fast enough to move before the car hits you.But for people with PTSD, such as Stephanie Romero and me, it doesn’t take a speeding car to set us off.Emotional Connections In The BrainIn a lab at Stanford University, scientists are using a technology called Functional Magnetic Resonance Imaging, or fMRI, to study the emotional reactions of patients with PTSD.“So we know, for example, when they’re faced with a reminder of their trauma, they don’t activate the circuitry we normally associate with emotional regulation, the ability to be resilient in an automatic effortless fashion,” says Dr. Amit Etkin, the project’s lead researcher.He says cortisol — that’s the same stress hormone that causes physical changes in the body — may also be responsible for the changes in the brain.“Over time, elevated cortisol can cause death of neurons in the brain, the kind that don’t get replaced,” he says.But that doesn’t mean PTSD can’t be treated. Scientists know talk therapy can be helpful. Etkin wants to understand how that kind of therapy might be repairing emotional connections in the brain. And he’s recruiting volunteers.The Blink Of An EyeStephanie Romero is one of the research subjects participating in the study. Ten months after her attack, she’s still having trouble feeling safe.“It’s always in the back of my head. Like, you just never know your life could change in the blink of an eye,” she says. “One minute you could be celebrating your birthday, and the next you’re in the hospital and you don’t know how you ended up there.In a room on the other side of a huge glass window, Romero lies in an fMRI machine, which looks like a big tube with a small hollow center. A monitor shows different angles of her brain.

“A lot of what we look at with emotion is focused on certain regions of the brain. One of them is the amygdala, which is really important not only for guiding your attention and focus on a threat stimulus, but also for affecting your body,” he says. “But somebody with PTSD doesn’t activate that circuitry well.”Etkin asks Romero several questions to help him identify which specific parts of the brain are affected by PTSD, and how she feels throughout the experiment.“Does she feel in her body at the moment, or is she feeling, like many PTSD patients report, feeling a little out of body, or detached, or unreal?” he asks.I can relate to that unreal feeling. It started to hit me right there in the lab. Etkin hopes by understanding how that feeling plays out inside the brain, scientists will be able to come up with more effective ways of treating this disorder, whether it’s through singing, talking, neuroscience, or all of the above.

and, from Soft Bipolar News, more on Dog PTSD, just for Blair:

Bryce Harper for The New York Times

Dereck Stevens bonds with his military working dog before a practice drill at Lackland Air Force Base in San Antonio. More Photos »

SAN ANTONIO — The call came into the behavior specialists here from a doctor in Afghanistan. His patient had just been through a firefight and now was cowering under a cot, refusing to come out.

Multimedia

Apparently even the chew toys hadn’t worked. Post-traumatic stress disorder, thought Dr. Walter F. Burghardt Jr., chief of behavioral medicine at the Daniel E. Holland Military Working Dog Hospital at Lackland Air Force Base. Specifically, canine PTSD. If anyone needed evidence of the frontline role played by dogs in war these days, here is the latest: the four-legged, wet-nosed troops used to sniff out mines, track down enemy fighters and clear buildings are struggling with the mental strains of combat nearly as much as their human counterparts. By some estimates, more than 5 percent of the approximately 650 military dogs deployed by American combat forces are developing canine PTSD. Of those, about half are likely to be retired from service, Dr. Burghardt said. Though veterinarians have long diagnosed behavioral problems in animals, the concept of canine PTSD is only about 18 months old, and still being debated. But it has gained vogue among military veterinarians, who have been seeing patterns of troubling behavior among dogs exposed to explosions, gunfire and other combat-related violence in Iraq and Afghanistan. Like humans with the analogous disorder, different dogs show different symptoms. Some become hyper-vigilant. Others avoid buildings or work areas that they had previously been comfortable in. Some undergo sharp changes in temperament, becoming unusually aggressive with their handlers, or clingy and timid. Most crucially, many stop doing the tasks they were trained to perform. “If the dog is trained to find improvised explosives and it looks like it’s working, but isn’t, it’s not just the dog that’s at risk,” Dr. Burghardt said. “This is a human health issue as well.” That the military is taking a serious interest in canine PTSD underscores the importance of working dogs in the current wars. Once used primarily as furry sentries, military dogs — most are German shepherds, followed by Belgian Malinois and Labrador retrievers — have branched out into an array of specialized tasks. They are widely considered the most effective tools for detecting the improvised explosive devices, or I.E.D.’s, frequently used in Afghanistan. Typically made from fertilizer and chemicals, and containing little or no metal, those buried bombs can be nearly impossible to find with standard mine-sweeping instruments. In the past three years, I.E.D.’s have become the major cause of casualties in Afghanistan. The Marine Corps also has begun using specially trained dogs to track Taliban fighters and bomb-makers. And Special Operations commandos train their own dogs to accompany elite teams on secret missions like the Navy SEAL raid that led to the killing of Osama bin Laden in Pakistan. Across all the forces, more than 50 military dogs have been killed since 2005. The number of working dogs on active duty has risen to 2,700, from 1,800 in 2001, and the training school headquartered here at Lackland has gotten busy, preparing about 500 dogs a year. So has the Holland hospital, the Pentagon’s canine version of Walter Reed Army Medical Center. Dr. Burghardt, a lanky 59-year-old who retired last year from the Air Force as a colonel, rarely sees his PTSD patients in the flesh. Consultations with veterinarians in the field are generally done by phone, e-mail or Skype, and often involve video documentation. In a series of videos that Dr. Burghardt uses to train veterinarians to spot canine PTSD, one shepherd barks wildly at the sound of gunfire that it had once tolerated in silence. Another can be seen confidently inspecting the interior of cars but then refusing to go inside a bus or a building. Another sits listlessly on a barrier wall, then after finally responding to its handler’s summons, runs away from a group of Afghan soldiers.

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